Author + information
- Thach Nguyen1,2,
- Le Thi Thuy Linh2,
- Thai Ba Anh Minh2,
- Luong Ngoc Tuyet Nhi2 and
- Gianluca Rigatelli3
During intervention of patients with ST segment myocardial infarction (STEMI) or chronic total occlusion (CTO), where is the lumen of the occluded artery so the operator can point the tip of the wire to ? Based on studies on shear stress, the plaques are formed in the low shears stress area so the lumen is left in the area with high shear stress. Where is the location of the lumen in the acutely or chronically occluded right coronary artery (RCA), left anterior descending artery (LAD), Left circumflex (LCX)? Where are the plaques in the left main (LM) to be avoided?
50 patients had acute or chronic occlusion in the RCA, 20 in the LCX, and 30 in the LAD. 25 ACS patients had LM lesion. The tip of the wires were pointed to the pericardial side or the myocardial side or along the carina side in case of bifurcations (LAD-LCX). After successful entry of the wires, the operators would record the location of successful entry: For the RCA: myocardial or pericardial side; for the ostial lesion of the LCX and LAD: carina or opposite side; for the mid LAD: myocardial or pericardial side; for the LM, the remaining lumen is in the inferior (base) or superior surface (roof) of the LM.
For the RCA, if the tip was pointed toward the pericardial side (to the right of the screen on LAO view), the success rate after first or second try was 85%. For the ostial LAD or LCX, the success after first or second try as the tip was pointed to the carinal side was 72%. For the mid LAD, the success was 75% if the tip was pointed to the left (pericardial) side on the AP cranial view. The remaining lumen was on the base of the LM in 80% if the height of the coronary sinus was significant. If the height of the coronary sinus was low, the remaining lumen was 80% on the upper border (roof) of the LM.
Following the results of studies on shear stress, the operators could guess correctly where the remaining lumen is in patients with STEMI, CTO, ACS. These infos help to correctly enter the true lumen and avoid subintimal passage of wire and balloon causing dissection of arterial segment distal to the index acute or chronic occlusion. These information also help the wire to enter safely the LM true lumen without disturbing the plaque during manipulation of devices.